Comfort Zone

Chapter 19

"I'll take that," the woman said, holding out her hand, diamonds flashing from her fingers. "Who are you exactly?"

"I was going to ask you the same," Miriam said.

"I'm Marilyn Fielding, the daughter. And the health care surrogate. The emergency room just contacted me. Now your turn, and I'll take my mother's bag from you."

Miriam handed over the bag. Definitely the real deal, she thought. "I'm Dr. Miriam Gotlin, covering for your mother's doctor."

"I see. Miriam Gotlin. The doctor who found the dead body." From the tone of her voice, Miriam expected to be accused of the crime.

Instead, there was silence as Marilyn Fielding looked at her mother. The sheet was now draped modestly around her, with the pacemaker in stark view.

"And what exactly is that thing on my mother's neck?"

Miriam put on her professional mask and a more placating voice. Sometimes people were worried sick, but she knew that more often they were worried obnoxious, and she couldn't really fault the woman for her attitude. They were both looking at the pacemaker apparatus, but while Miriam saw a magnificent technologic life sustainer, the daughter likely saw only a tentacled alien imbedding itself in the tender flesh of her mother's neck.

"Your mother fell down while grocery shopping and the store called 911," she said soothingly. "She was breathing on her own and still is, but her heart was beating too slowly to pump blood to the rest of her body, so she passed out. It's possible she had a heart attack, or that her heart's natural rhythm-maker is malfunctioning. The paramedics and emergency room resuscitated her and put in a temporary pacemaker." Miriam pointed to the device, then up to the screen. "You can see from the monitor that her heart's beating at a rate of eighty, which is just fine. The good news is she'll likely wake up and recover completely.

"A cardiologist will be coming in soon to talk to you about putting in a permanent pacemaker so this won't happen again--"

"Absolutely not."

"Excuse me?"

"Absolutely not. My mother said many times that when her time came, she was ready. She wanted no extraordinary measures done. I will not give consent for this procedure."

Some awful ER smell seeped into the cubicle. Miriam resolutely ignored it, but took some mean satisfaction in the other woman's expression.

"Ms. Fielding, a pacemaker isn't an extraordinary measure."

"It is to me, and it would be to my mother. She was—is--a hospital volunteer and knows how things work. And since my mother can't speak, I will advocate on her behalf. She's been ill for a long time—"

"Ill with?"

"She has several medical problems as you'll see if you take the time to review her records."

Miriam had done so, and failed to find any dreadful disease listed.

"Maybe she said she's ready to go because she's depressed. We can treat that too."

"She's not depressed," the daughter snapped. "Why should she be depressed? She has a great life. No problems at all."

"But you said she was dealing with serious illnesses."

"Except for that."

"Does she have a living will, laying out what she'd want done in a situation like this?"

"She doesn't need one. She named me surrogate instead. She trusts me implicitly and knows I will choose for her exactly what she would want."

Miriam grudgingly acknowledged that Marilyn knew her stuff when it came to autonomy and advance directives. There were various options for people who wanted to make their wishes known in the event they were incapacitated. A living will was one tool; naming a surrogate to speak for them when they no longer could was another.

When it came to DNR orders, though, Marilyn's knowledge faltered. She'd asked—no, demanded--that Miriam enter a Do Not Resuscitate order on the chart, but Miriam had risked her fury by not doing so. The law was on her side; if Lilly Fielding was awake and requested one like Ms. V, that was one thing, but the situation was entirely different now that she wasn't.

A DNR order can be written for an unresponsive patient, but only if the person has either previously requested one, or has a documented terminal condition. Ms. Fielding had never signed a DNR order for herself, and a quick review of her records revealed nothing lethal.

The ER attending came by and joined them at the bedside. He introduced himself and reiterated Miriam's sentiments, explaining the simple procedure necessary to implant a permanent pacemaker. The battery lasts for years, he explained.

"It's not that kind of battery that worries me, it's the legal type. I'm sure you both know what I mean, and will make sure nothing is done to my mother that she wouldn't want." Marilyn Fielding clutched the Coach bag and turned abruptly away, her elegant figure cutting through the air, which suddenly felt heavy and oppressive, as if the July day had sneaked in, and hijacked the AC.

"Nice lady if you like Attila the Hun," the attending said to Miriam after the daughter had moved out of earshot. "I would recommend an ethics consult. Stat."

Miriam stared at him. "That would be me," she said.

How had Tatiana unloaded this on her? Miriam asked herself. Not only on a weekend, but on her vacation. "Call me if something insurmountable comes up," she usually said. "I'll hate you but I'll be home. I don't do shit on weekends anyway." But now, this week she was doing shit, or whatever the opposite word was that described some sublime action. Tatiana Powell was volunteering with Medecins Sans Frontieres in some small poverty and catastrophe-stricken island, and she was absolutely unreachable for the entire week.

And Miriam Gotlin was entirely on her own.